Non-verbal Intelligence in Unilateral Perinatal Stroke Patients With and Without Epilepsies

Gschaidmeier, Alisa; Heimgärtner, Magdalena; Schnaufer, Lukas; Driever, Pablo Hernáiz; Wilke, Marko; Lidzba, Karen; Staudt, Martin

doi:10.3389/fped.2021.660096

Cited by 8 publications

(4 citation statements)

References 41 publications

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“…Moreover, at 2-year follow up, outpatient physical therapy was required for 24%, speech therapy for 21%, and occupational therapy for 18% of children. While children with large left-sided perinatal strokes can have normal language development secondary to presumed right hemispheric reorganization [37], poststroke epilepsy was identified as an independent risk factor for deficits in both verbal communication and nonverbal intelligence (e.g., problem solving and abstract reasoning) [38,39].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, causes, and morbidities of stroke in the young

Janas,

Barry,

Lee

2023

Current Opinion in Pediatrics

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Purpose of review The purpose is to describe the latest research on epidemiology, causes, and morbidities of stroke in neonates and children. Recent findings The global incidence of childhood stroke is approximately 2 per 100 000 person-years, which is significantly lower compared to neonates (20–40 per 100 000 live births) and adults (80–90 per 100 000 person-years). Placental abnormalities are a risk factor for perinatal stroke, although cause is usually multifactorial. In children, nonatherosclerotic arteriopathies and arteriovenous malformations are major causes of ischemic and hemorrhagic strokes, respectively. The perinatal period confers a high risk of stroke and can lead to long-term disability, including motor delay, cognitive or speech impairment, and epilepsy. Recent studies suggest that at least 50% of survivors of perinatal stroke have abnormal neurodevelopmental scores in long-term follow up. Childhood stroke is associated with significant morbidity, including epilepsy, motor impairments, and behavioral disability. Recent studies have also identified an association between pediatric stroke and behavioral disorders, such as attention deficit hyperactivity disorder and autism. Summary Perinatal and childhood strokes are important causes of neurological morbidity. Given the low incidence of childhood stroke, prospective research studies on epidemiology, causes, and outcomes remain limited, highlighting the need for continued multisite collaborations.

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Section: Discussionmentioning

confidence: 99%

Epidemiology, causes, and morbidities of stroke in the young

Janas,

Barry,

Lee

2023

Current Opinion in Pediatrics

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“…Éstas son difíciles de predecir e incluso a veces de diagnosticar, especialmente en los primeros años. Hay estudios que resaltan que, incluso en infartos izquierdos extensos, el lenguaje se preserva [ 13 , 38 ], a diferencia de lo que ocurre en los adultos, ya que el hemisferio contralateral podría asumir su función [ 1 , 15 , 40 ]. Nosotros tampoco encontramos diferencia estadísticamente significativa en la frecuencia de alteraciones del lenguaje entre el ictus en el hemisferio izquierdo y el derecho.…”

Section: Discussionunclassified

“…La epilepsia se ha descrito de forma clásica aproximadamente en un tercio de los pacientes con IIAP, aunque, según las series consultadas, los porcentajes varían del 15 al 60% [ 4 , 15 , 28 , 33 , 37 , 40 , 41 ]. Este riesgo y la demostración de la existencia de una importante relación entre la epilepsia y la alteración del neurodesarrollo [ 13 , 36 ] han sostenido la tendencia a mantener el tratamiento anticrisis tras el alta en porcentajes que llegan al 80% en algunas series [ 42 ].…”

Section: Discussionunclassified

Serie de 22 casos de ictus isquémico arterial perinatal: factores de riesgo, manejo clínico y secuelas neurológicas

Arias Llorente,

Lareu Vidal,

González Sánchez

et al. 2023

RevNeurol

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Introducción. El ictus cerebral isquémico arterial perinatal (IIAP) es una entidad casi tan frecuente como en la época adulta, que ocasiona secuelas neurológicas importantes. Objetivo. Describir las situaciones de riesgo que rodean a estos neonatos, la clínica que manifiestan, el manejo, la rentabilidad de las pruebas diagnósticas y las secuelas neurológicas. Pacientes y métodos. Estudio observacional de una cohorte de pacientes formada por neonatos ≥ 35 semanas de edad gestacional diagnosticados de IIAP entre 2010 y 2021 en nuestro hospital. Resultados. Se incluyeron 22 casos de IIAP, y su incidencia en nuestro centro fue de 1/1.869 recién nacidos vivos. El 81,8% tuvo algún factor de riesgo intraparto y en el 40,9% se aglutinaron varios. Comenzó con convulsiones (edad media 27,3 horas) el 77,3% de casos. Los pacientes con ictus del hemisferio izquierdo tuvieron más secuelas (77,8%) en comparación con los derechos (16,6%) ( p = 0,041), a expensas de la parálisis cerebral infantil ( p = 0,04), mientras no encontramos diferencia en la frecuencia de alteraciones del lenguaje ( p = 0,06) entre hemisferios. El tiempo medio de seguimiento fue de 6,13 años ± 3,06. El 63,6% de los neonatos tuvo secuelas neurológicas: parálisis cerebral infantil (40,9%), trastornos del lenguaje (22,7%) y discapacidad intelectual (9%). Desarrolló epilepsia el 18,2% (entre 0,25 y 1,8 años) y se mantuvo el tratamiento anticrisis tras el alta en el 37,5% de los casos en los últimos años del estudio. Conclusiones. Ante un neonato con convulsiones hay que descartar un ictus cerebral. El IIAP ocasiona secuelas neurológicas en más del 60% de los casos. Su identificación precoz es fundamental para mejorar el pronóstico neurológico y evitar el uso prolongado de fármacos anticrisis cuando resulte posible.

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“…Epilepsy can be a key risk factor for impaired non-verbal intelligence after perinatal AIS and PVI ( 13 ). Sleep-related electroencephalographic (EEG) abnormalities, such as spike and wave discharges, occurring during >75% of sleep, have been associated with worse developmental outcomes in language and behavior in children with perinatal AIS ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

The thalamus and basal ganglia are smaller in children with epilepsy after perinatal stroke

Vaher,

Ilves,

Ilves

et al. 2023

Front. Neurol.

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BackgroundEpilepsy is one of the most serious consequences of perinatal stroke. Epilepsy itself has been proposed as a risk factor for impaired cognitive, language, and behavioral functioning. It is still unclear which children develop epilepsy after perinatal stroke. The current study aimed to evaluate the volume of the thalamus and the basal ganglia in children after perinatal stroke in relation to poststroke epilepsy.MethodsThe follow-up study included 29 children with perinatal arterial ischemic stroke (AIS), 33 children with presumed periventricular venous infarction (PVI), and 46 age- and sex-matched healthy controls. Magnetic resonance imaging was performed in children between the ages of 4 and 18 years, and volumetric analysis by segmentation was used to evaluate the size of the thalamus, caudate nucleus, putamen, globus pallidus, hippocampus, amygdala, and nucleus accumbens.ResultsDuring a median follow-up time of 12.8 years [interquartile range (IQR): 10.8–17.3] in the AIS group and 12.5 years (IQR: 9.3–14.8) in the PVI group (p = 0.32), epilepsy developed in 10 children (34.5%) with AIS and in 4 (12.1%) children with PVI, p = 0.036 [odds ratio (OR) = 3.8, 95%, confidence interval (CI): 1.04–14]. Epilepsy and interictal epileptiform discharges (IEDs) without clinical seizures were more often expressed in children with AIS (n = 16, 55%) than in children with PVI (n = 7, 21.2%), p = 0.0057 (OR = 3.8 95% CI: 1.04–14). In the AIS group, the ipsilesional and contralesional thalamus, ipsilesional caudate nucleus, and nucleus accumbens were significantly smaller in children with epilepsy compared to children without epilepsy. In the PVI group, the ipsilesional thalamus, caudate nucleus, and nucleus accumbens were smaller in the pooled group of epilepsy plus IED alone compared to children without epilepsy.ConclusionIn children with AIS, epilepsy or IED occurred more often compared to children with PVI. Both patients with AIS and PVI with severe damage to the basal ganglia and the thalamus have a higher risk of developing poststroke epilepsy and should be monitored more closely throughout childhood to initiate timely antiseizure medication and rehabilitation.

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Non-verbal Intelligence in Unilateral Perinatal Stroke Patients With and Without Epilepsies

Cited by 8 publications

References 41 publications

Epidemiology, causes, and morbidities of stroke in the young

Epidemiology, causes, and morbidities of stroke in the young

Serie de 22 casos de ictus isquémico arterial perinatal: factores de riesgo, manejo clínico y secuelas neurológicas

The thalamus and basal ganglia are smaller in children with epilepsy after perinatal stroke

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